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Yes. There is a grass-roots organization providing letter templates, telling people which senators to call, and so on.:Vaccinate California SB 277 has a powerful roster of supporters, as of April 8 (I haven't updated the list since then):Vaccinate California (sponsor)American Academy of PediatricsAmerican Lung AssociationBiocomCalifornia Association of Nurse PractitionersCalifornia Chapter of the American College of Emergency PhysiciansCalifornia Children’s Hospital AssociationCalifornia Coverage and Health InitiativesCalifornia Immunization CoalitionCalifornia Medical AssociationCalifornia Optometric AssociationCalifornia School Nurses OrganizationCalifornia State Parent-Teacher AssociationChildren NowChildren’s Defense Fund CaliforniaChildren’s Specialty Care CoalitionCounty of Los AngelesCounty of Santa CruzHealth Officers Association of CaliforniaInsurance Commissioner Dave JonesKaiser PermanenteMarch of Dimes California ChapterProvidence Health and Services Southern CaliforniaSan Francisco Unified School DistrictSecular Coalition for CaliforniaSilicon Valley Leadership GroupSolano Beach School DistrictThe Children’s PartnershipHundreds of individualsBy contrast, here are the organizations (with my commentary) opposing SB277.[Health Committee Analysis] Association of American Physicians and Surgeons (AAPS)"The Association of American Physicians and Surgeons Inc. state that the need for informed consent is a firmly established principal of medical ethics and human rights and that the state has no right to force medical interventions on people without their consent"About AAPShttp://www.aapsonline.org/Rational Wiki:Association of American Physicians and SurgeonsThe Association of American Physicians and Surgeons is a small group of physicians who advocate for far-right conservative values in the practice of medicine. While purporting to have high regard for the Hippocratic Oath, "the sanctity of the patient-physician relationship, and the "practice of private medicine"[1], it appears to treat these concepts as terms of art. Despite also calling itself "non-partisan", its main focus appears to be opposing abortion, vaccination, universal health care coverage and Obamacare in particular, and birth control.---------------------[Health Committee Analysis] California Chiropractic Association"The California Chiropractic Association mentions that the Mayo Clinic warns against undermining the principle of informed consent in favor of universal vaccination and further states we ought not let a handful of measles cases at Disneyland turn into a full-scale assault on civil and human rights in America. "About CCAhttps://www.calchiro.org/Oppose SB 277 - Elimination of Vaccination Personal Belief Exemption"Stay with the framing of the issue provided. It’s about choice/informed consent. We are NOT anti-vaccine we are pro-informed consent and choice. Make the case that the data (provided in our talking points) demonstrates there are risks to taking the vaccine so there should be choice. "-------------------------[Health Committee Analysis] California Naturopathic Doctors Association (unless amended)"California Naturopathic Doctors Association (CNDA) states that it supports immunization for the prevention of disease and the public health objective of achieving high rates of immunity to infectious disease. CNDA states that as licensed primary care doctors who can diagnose medical conditions such as anaphylaxis and immunodeficiency, reasons outlined in the CDC’s list of contraindications to common pediatric vaccinations, naturopathic doctors must also be able to sign medical waivers for vaccination, when such medical conditions exist. CNDA opposes this bill unless it is amended to include NDs as providers who can sign medical waivers for vaccination."About CNDAhttp://www.calnd.org/[nothing on the website about SB277. Marty Block toured Bastyr University California in October 2014., and is the author of an expansion of practice bill for naturopaths.During the tours, students spoke about their education and their chosen profession. Says Adam Silberman, a third-year naturopathic medical student, “Being able to walk Senator Block and his staffer Roberto Alcantar through our clinic – explaining to them our philosophy of care and strong clinical training – brought me a strong sense of pride and excitement. How we are learning to work with patients will transform health care in California, and I think Senator Block and Congressman Hunter both saw that first-hand during their visits.”Lawmakers Tour Bastyr University CaliforniaMarty Block is the only sponsor for SB538, a bill that would greatly increase naturopaths' scope of practice.Bill StatusCuriously, there's nothing about the bill on his website.Senator Marty Block Legislative Update--------[Health Committee Analysis] California Nurses for Ethical StandardsAbout CNESBig issue is opposition to abortion and sex ed in schools.http://ethicalnurses.org/http://ethicalnurses.org/?p=2703SB277 seeks to remove the Personal Belief Exemption and mandate full vaccination of any pupil, from daycare through secondary school, public and private, in order to attend. Additionally, SB277 does not limit the ever-expanding vaccine schedule or the requirement of additional vaccines to attend school; in 2012 there were nearly 300 new vaccines in the pipeline. CNES strongly asserts principals of informed consent, personal belief, medical, religious, and philosophic exemptions, in accordance with the AMA and in the interest of maintaining ethical integrity in our public health laws. California Nurses For Ethical Standards oppose SB277.“If there is a risk then there should be a choice”[from hearing ] 1:30:03 California Nurses for Ethical Standards--------[Health Committee Analysis] California ProLife CouncilAbout California ProLife CouncilAction Alert!SB 277 – Mandated Childhood Vaccines Intrude on Parental Rights (Pan) – OPPOSEThis bill strives to eliminate the personal belief exemption option from the school immunization law forcing parents to vaccinate their children from all diseases deemed necessary by the Department of Public Health (DPH). Some immunizations use tissue from aborted babies.------------[Health Committee Analysis] California Right to Life Committee, Inc.http://www.calright2life.org/[nothing on webpage, most likely similar to California ProLife Council.]------------[Health Committee Analysis] Canary Party"The Canary Party maintains that the United States Justice System deems each and every vaccine on the market as “unavoidably unsafe”, which means that even when used as directed, someone will be harmed, or may even die from the vaccine. "About the Canary Party"The Canary Party is a tiny organization focused on promoting the idea that vaccines cause autism. They have branched out some with GMOs and “health freedom”, but their core seems to be the failed idea that vaccines cause autism. "More Canary Party financial documentsJennifer Larson, who is with the tiny “Canary Party”. Tax documents indicate that Ms. Larson is a large financial backer of the Canary Party. Searching for what donations Ms. Larson has made (using OpenSecrets.org, the Center for Responsive Politics) I found a total of $40,000 donations to Congressman Issa, his PAC and the Republican National Committee though Ms. Larson and her company Vibrant TechnologiesOne year and $40,000 later and another hearinghttp://www.canaryparty.org/[almost defunct organization; has been replaced by Barry Segal's Focus for Health, it appears. ]You Simply Have To Be Pro-Health - Focus for Health[from hearing ] 1:21:03 Canary Party------------[Health Committee Analysis] Capitol Resource Institute"The Capitol Resource Institute notes that following the passage of AB 2109 the personal belief exemption rate fell from 3.1 percent in 2013 to 2.5 percent in 2014 after only a partial implementation of the law, and that this bill is far reaching and unnecessary. "About the Capitol Resource Institutehttp://capitolresource.org/about-us/"CRI’s mission is to educate and strengthen families and we do that by working to influence public policy. It’s imperative that citizens join with us in staying up to speed on current legislation affecting family values! As your watchdog for family values here in Sacramento, CRI is committed to keeping you informed about important legislation. So, stay tuned!"Against LGBT issues being taught in school, against same-sex marriage, extremely Christian oriented.------------[Health Committee Analysis] Educate. Advocate."Educate. Advocate. writes that every medical intervention has both benefits and risks and that parents, not the State of California, have the right to decide which medical interventions their children receive"About Educate.Advocate."To assist and provide support to anyone with or connected to someone with special needs and/or disabilities at any age in the area surrounding mainly San Bernardino and Riverside county in California."Board members:Kristie Reneé Sepulveda-Burchit, Amy Carrillo, Marilyn Interian, Jerri Carpinteyro[many members believe their children are vaccine injured][from hearing ] 2:12:24 Educate Advocate------------[Health Committee Analysis] Families for Early Autism Treatment [FEAT]" Families for Early Autism Treatment contend that this bill is contrary to the rights protected by the State and Federal Constitutions as it denies rights to privacy, education, free assembly, religious expression, consensual use of one’s physical body and liberty. "About FEAT"FEAT is a non-profit, volunteer-driven organization of parents, family members, and treatment professionals dedicated to providing best outcome Education, Advocacy and Support for the Northern California Autism Community."[many members believe that vaccines caused their children's autism]------------[Health Committee Analysis] Homeschool Association of California"The Homeschool Association of California states this bill will negatively impact the freedom to homeschool and would make it impossible for many families to choose to homeschool legally. They argue that almost all homeschooling families use a legal option that involves attendance at some form of public or private school, either operated by a third party or operated by parents who file a private school affidavit, yet current law requires children admitted to private schools be fully vaccinated in accordance with existing law."AboutHSC[nothing on the website.][from hearing ] 1:25:40 Home School Association of California------------[Health Committee Analysis] National Vaccine Information Center"The National Vaccine Information Center argues that it’s particularly disturbing that physicians in the American Medical Association Code of Ethics affirm philosophical and religious exemptions for themselves yet want to remove this right for California parents."About NVICDespite its name, it is not a government body. It is a nonprofit whose mission is to create fear and doubt about the safety and efficacy of vaccines. The best introduction:NVIC? Know the Omissions------------[Health Committee Analysis] Pacific Justice Institute Center for Public Policy"The Pacific Justice Institute argues that statewide vaccination rates exceed the threshold for herd immunity and, to the extent that a few communities have fallen below vaccination levels needed for herd immunity, the Legislature could consider approaches that allow greater local decision-making and accountability rather than imposing across-the-board statewide mandates."About -- from Wikipedia.PJI provides pro bono representation in matters involving the exercise of religion and other civil liberties. It has supported the recitation of "under God" as part of the Pledge of Allegiance in public schools, homeschooling, and the enforcement of the Religious Land Use and Institutionalized Persons Act.In 2014, the Southern Poverty Law Center designated the Pacific Justice Institute as an anti-LGBT hate group.------------[Health Committee Analysis] ParentalRights.orgAbout"ParentalRights.Org's mission is to protect children by empowering parents through adoption of the Parental Rights Amendment to the U.S. Constitution and by preventing U.S. ratification of UN Conventions that threaten parental right:" It is primarily organized in opposition to the UN Convention On The Rights Of The Child, which has long been a dog-whistle element in the far right.------------[Health Committee Analysis] SafeMindsAboutSafeMinds is an acronym for Sensible Action For Ending Mercury Induced Neurological Disorders. It is a parent-advocacy group that originally advanced the belief that thimerosal in vaccines cause autism; it has since morphed into a general-purpose anti-vaccine, autism-hating organization. It used to have rather a lot of clout; the failure of the mercury-causing-autism hypothesis in the Omnibus Autism Hearing (OAR) seems to have made the organization much less relevant.SAFEMINDS board:Sallie Bernard (New Jersey)Lyn Redwood, RN, MSN (Georgia)Heidi Roger (New Jersey/New York)Laura Bono (North Carolina)Maria Dwyer (New York)Albert EnayatiStephen D. KetteScott LasterJackie Lombardo (Virginia)Cynthia Nevison (Colorado)Katie Weisman (New York)Katie Wright (Connecticut)------------Hundreds of individuals------[from hearing ] 1:16:25 Ruth Westerich (sp) claiming to speaking for a San Diego "group of over 500,000 healthcare practitioners"-------[from hearing ] 1:17:59 Wendy Silver; Million Mamas MovementPrimarily a peace movement but also no vaccines, evidently.Become a Million Mama - Million Mamas Movement-------[from hearing ] 1:18:35 Slow and No Vax Moms"extensive yahoo group in your area for parents. It's called slow and no vax moms. Look it up, and they should be able to help you."Yahoo! Groups"This group does not advocate any vaccine over another as they all have adverse effects. All discussion is from a "con" stance for each and every vaccine. This is not a place for debate of the vaccine issues. Discussing the "pro" viewpoint of any vaccine is not a part of this forum in any way."---------[from hearing ] 1:18:55 Campaign for Liberty, asks Senator Allen for a dateRon Paul's groupCampaign for Liberty - Reclaim the Republic. Restore the Constitution.---------[from hearing ]1:21:56 Laura Hayes; Mind Institute, FEAT, California Coalition for Health Choice, Canary PartyHayes of the founding families of MIND Institute; still fixated on vaccines cause autism. She's been published at the anti-vaccine, autism-hating blog Age of Autism.David Gorski, writing as Orac, has addressed her issues:No, no, no! Fifteen times, no!Tactics and tropes of the antivaccine movement (2014 edition)The annals of “I’m not antivaccine,” part 14: Vaccine “Trafficking” and beyond-----------[from hearing ]1:27:51 Our Kids, Our Choice(seems to be a subgroup of the other antis, focusing on producing Youtube Videos)-------[from hearing ] 1:30:30 Congressional Prayer Conference of Washington DC, spoke about the letter they sent to Senator Pan the day before and is very aggressive in tone. Laughter from oppo when he finishes------[from hearing ] 1:40:35 Dr. Bob Sears[anti-vaccine pediatrician]-------[from hearing ] 1:48:20 Environmental Voiceshttp://environmentalvoices.org/index.htmlRocklin-based anti-GMO, anti-toxins organization.--------[from hearing ] 2:00:03 National Autism Association of CAHelp and Hope for Families Affected by Autism[believes that vaccines cause some or most cases of autism. National organization with state chapters -- several in California]-----[from hearing] Dana Gorman, Thriiive.com and #b1less

Out of three questions, first two questions are answered here Surbhi Tripathi's answer to What is the Nipah virus, and how is it transmitted?The last question which is most important one to answer is about government's measures on NiV. As India is one of the member state of World Health Organisation so the preparedness for NiV is recommended by WHO will be apt to apply in India:Surveillance, Prevention and Control ofNipah Virus Infection: A Practical HandbookPage No. 18–354. OUTBREAK OR EMERGENCY PREPAREDNESS AND RESPONSE FOR NiV4.1. PreparednessPreparedness in terms of technical and logistical management of a Nipah outbreak is essential in countries with recurrent outbreaks. The best response to a Nipah outbreak is being able to detect cases as early as possible and prevent further infections.4.1.1. Enhancing surveillance during the NiV transmission seasonSurveillance should be intensified during the Nipah season from January through May, when most Nipah outbreaks have been identified. This will increase the possibility of identifying NiV infection and understanding the characteristics of the virus. Blood, CSF, urine and throat swabs are collected from suspected patients and sent to the reference laboratories.4.1.2. Awareness building in hospitals and raising community awareness• Encourage and train health-care workers to maintain standard infection control precautions, e.g., personal hygiene, use of personal protective equipment(PPE), and manage encephalitis or neurological patients appropriately.• Disseminate information to communities through multimedia, leaflets, posters and meetings (group, community and market) encouraging people:o to stop consumption of raw date palm sap;o not to eat fruit partially eaten by bats;o cover the mouth and nose while caring for unconscious patients;o wash hands with soap and water before and after feeding and taking care of patients.4.1.3. Infection control in health-care settings should be in place• Implement standard infection control precautions.• Acquire and maintain PPE stock and other equipment needed in epidemiological investigations and outbreak response.4.1.4. Planning for outbreak response: some major components4.1.4.1. Formation of a multisectoral team 20Since NiV infection is a zoonosis and outbreaks may be associated with multiple factors such as animal reservoirs, sociocultural practices, food habits and possible human-to-human transmission, a multidisciplinary team is needed, and preparation should be done for pre-outbreak, outbreak and post-outbreak phases.A multisectoral team should be built up at national and local levels for the monitoring, evaluation and response to unusual acute public health events and outbreak response, including Nipah outbreaks. The team should have a holistic, multidisciplinary approach consisting of public health personnel, clinicians and laboratory personnel. The multisectoral team may consist of the following professionals (depending on the evolving and country-specific situation) who would bring relevant expertise in outbreak investigation and response:• epidemiologist• microbiologist• anthropologist and/or social scientist• veterinarian• ecologist.National or subnational level – Rapid Response Team (NRRT): The NRRT should be assigned from institutes at the national/provincial level and partner institutes.District/provincial level – District Rapid Response Team (DRRT): The DRRT consists of the head of health services at the district/provincial level and clinical and laboratory expertise, and other expertise from the public health department.4.1.4.2. Evaluate and ensure the supplies for sample collection, storage and shipment of samples:• Assess PPE in stock;• Assess sample collection instruments;• Assess sample storage capacity in the laboratory;• Evaluate laboratory capacity for NiV testing (e.g., biosafety, quality, skills, human resources and consumables for NiV virus testing);• Evaluate hospital capacities for isolation facilities and ability to treat Nipah patients in Nipah-prone areas.4.2. Alert and outbreak investigationThe outbreak investigation should lead to formulation of an appropriate public health intervention as soon as the source and mode of transmission are known. In the meantime, control measures mitigating known risk factors should be implemented as soon as NiV transmission is suspected.4.2.1. Investigation of a suspected case or cluster of suspect cases:4.2.1.1. Standard Operating Procedures (SOPs) for sample collection and transportation in place:• Surveillance physician will take verbal consent from patient or patient’s family member;• Collect 5 ml venous blood;• If possible, collect 3 ml extra-CSF when appropriate;• Aliquot 1 ml serum and 1 ml CSF samples in 1.8 ml cryovial tube. Try to aliquot serum and CSF samples in three cryovial tubes;• Label the cryovial tube with: type of samples (serum/CSF), patient name and identification number, and date of sample collection;• Store the serum and CSF samples in liquid nitrogen if possible, or −20°C freezer for short-term storage if liquid nitrogen is not available;• Ship samples in liquid nitrogen tank or ice pack to assigned centre for laboratory diagnosis;• Store samples in −70°C freezer for longer-term storage;• A list of potential national or international reference laboratories should be pre-established. There can be several for different purposes: a frontline laboratory would be the WHO Collaborating Centre for laboratory diagnosis of viral diseases with BSL 3 or BSL 4 facilities (see list of WHO Collaborating Centres and other institutions for laboratory diagnosis, surveillance and response in Appendix 4).4.2.1.2. Templates of data collection instruments pre-developed and in place for quick useThese templates should include the following:• line listing of all cases;• case reporting form;• questionnaire for case-control studies or other relevant studies;• forms for sample collection.4.2.1.3. SOP for activating and conducting outbreak investigation teamsThis SOP is commonly country-specific as the process relies on the administrative structures and capacity or resources of a given country. Therefore a country-based manual or protocol for outbreak investigations should be in place in at-risk countries forNipah outbreaks. A more generalized national SOP manual for all emerging or re-emerging infectious diseases of international concern could be developed focusing on a mechanism of response and roles and responsibilities of different parties.The following are some of the key components to prepare a team for outbreak investigation:1) National or Subnational Rapid Response Team (RRT) Should an outbreak of NiV virus disease be suspected and/or reported, the National RRT should be activated and should meet together to:(1) Plan and conduct the investigation;(2) Request further technical support if needed (e.g., further analysis and interpretation, risk communication, initiate control).2) Administrative SOP for field work in place: administrative clearance, organize supplies, travel arrangements:• approval/permission from competent authority;• arrangement for accommodation;• arrangement for security, if needed;• arrange vehicle;• supplies:o medicineso sample collection instrumentso PPEo disinfectants, hand sanitizero basic medical and investigation equipment, e.g., stethoscope, thermometer, GPS instrument, etc.3) SOP for rapid mobilization of additional or experts teamsIf the NiV outbreak is confirmed, an experienced Nipah outbreak investigation team comprising an epidemiologist, clinician, veterinarian and anthropologist or social scientist can move to the field within 24 hours of outbreak reporting.4.2. 1.4. Nipah outbreak investigationThe overall objective of investigating Nipah outbreaks is to control the outbreak and prevent future outbreaks. Any Nipah (or suspicion of) outbreaks should be investigated as the disease is of public health concern with potentially devastating consequences.The specific objectives include the following:• to determine the extent of the outbreak;• to characterize the populations at greatest risk and to identify specific risk factors;• to provide practical recommendations to strengthen control and prevention measures.Key steps when conducting Nipah outbreak investigationStep 1: Activate preparation plan for outbreak investigation (details above).Step 2: Confirm the outbreak.One of the first tasks of the initial investigation team is to verify that a suspected cluster of cases is indeed a real outbreak with common cause. Some will be unrelated cases of the same disease, and others will turn out to be real cases of AES or ALRI but of unrelated diseases. This step consists of confirming the diagnosis through visiting the outbreak affected areas to (1) examine the patients and/or review the medical charts to describe and understand the clinical presentation; (2) collect blood, CSF and throat swab samples at the time of admission/ first contact, and follow-up serum samples 2 weeks after the onset of illness for testing.A Nipah outbreak is defined as the identification of at least one laboratory-confirmed case.Step 3: Define and identify cases.The investigators should develop or adapt standardized case definitions appropriate to the outbreak context (see details in standard case definitions). Testing for NiV infection should be performed when there are: (i) clusters of AES due to an unknown agent or (ii) patients with AES due to an unknown agent living in or near NiV zones.Patients with AES should also be tested for NiV infection when they are exposed to a cluster of unexplained neurological/pulmonary illness in animals, such as horses and pigs.Step 4: Case-findingIn many outbreaks, including Nipah outbreaks, the first cases that are recognized are usually a small proportion of the total number. Retrospective and prospective case-findings are crucial to determine the true magnitude and geographical extent of the outbreak.Active case-finding should be conducted:Among close contacts:• A close contact is defined as “a patient or the person who came in contact with a Nipah case (confirmed or probable cases) AND stayed in the room or veranda or vehicle for at least 15 minutes”.• Record contacts for potential follow-up if need be. They are to be followed up in case of occurrence of illness (up to 18 days). Serum specimens should be collected in case of symptom onseto in high-risk groups or in groups exposed to the sourceo through enhancing surveillance in the outbreak area and the at-risk areas for case-finding in the communityStep 5: Evaluate the outbreak in relation to ‘time, place and person’• establish a line-list of current and previous cases;• draw an epidemic curve;• analyse and interpret the data to identify potential sources of transmission.Step 6: Develop and evaluate hypothesesOnce step 5 has been done, investigators should have some hypotheses regarding the source and/or mode of transmission and the exposures that caused the disease. These hypotheses should be compared with established facts.Step 7: Refine hypotheses and carry out additional studiesIf step 6 is not conclusive, these hypotheses can be refined to look for new modes or vehicles of transmission and be evaluated through conducting case–control studies.Step 8: Implement control and prevention measures (see response section below)Step 9: Communicate findings and information about risks (i.e., outbreak report)• Develop an outbreak report and disseminate to concerned authorities.• Learning from the outbreak includes detailing:o new findingso major limitations during outbreak investigation• Resume the activities of pre-outbreak phase.4.3. Additional considerations with respect to Nipah outbreaksWhen the Nipah outbreak is confirmed, the investigation team needs to:• Immediately inform the local, regional and national authorities.• Inform the partners/stakeholders (notably those involved at local level): treating hospitals, patients’ relatives.• Declare the Nipah outbreak to WHO under the International HealthRegulation 2005 (IHR) via National IHR focal points (see detail below in the response section).Notification and assessment of Nipah outbreak and/or cases to WHO should be based on the following four criteria described in Annex II of IHR 2005. A "yes" to any of the four criteria would lead to notifying WHO under Article 6 of the IHR.• Is the public health impact of the Nipah outbreak and/or cases serious?• Are the Nipah outbreak and/or cases unusual or unexpected?• Is there a significant risk of international spread?• Is there a significant risk of international travel or trade restrictions?4.3.1. Conduct rapid risk assessmentSome of the major risk assessment questions should include the following:• What is the risk of occurrence of further cases from the detected outbreak?• What is the risk of spread of the infection?• What is the risk of major impact of the current outbreak on the health-care system?4.3.2. Evaluate the impact of control measuresEach outbreak should be thoroughly investigated, and lessons learnt from each outbreak should be evaluated and documented so that control measures can be reviewed and modified as required.4.3. 3. Develop further research with the objective of identifying determinants of infection or severity and determining modes and dynamics of infectionThe populations to be investigated would be those exposed to NiV:4.3.3.1. Health-care workers (HCWs)There is evidence of nosocomial transmission in India and Bangladesh, and one nurse was positive to Nipah IgM antibody in Malaysia (3, 4). HCWs are to be trained for infection control and prevention (see below). Surveillance should be in place to detect any suspected cases among HCWs. In addition, a study should be conducted to identify asymptomaticcases among HCWs who provided service to Nipah patients. Among these, positive cases should be subsequently compared with negative ones to determine risk factors for infection and understand the dynamics of transmission. Some components of the study could include:• Make a list of HCWs who provided care to Nipah patients.• Take consent from HCWs.• Interview at-risk HCWs using an exposure questionnaire, about 3 weeks after the last exposure to NiV-infected patients.• Collect 5 ml of blood for serology testing about 3 weeks after the last exposure to NiV-infected patients.4.3.3.2. Communities potentially exposed to NiVThe investigation should encourage involvement of multidisciplinary and multisectoral team using a one-health approach. For instance, investigators should have the support of microbiologists and their laboratories to conduct community-based seroprevalence surveys (detection of recent antibody response) to determine the extent of the outbreak via detecting subclinical and/or asymptomatic cases. Asymptomatic cases could be further compared with controls to identify risk factors for infection.Anthropologists or other social scientists with extensive community-based experience could help propose additional behaviour risk factors to be tested in a case–control study. Anthropologists should work with communication/health promotion specialists to develop communication messages combining both local explanatory models and biomedical models using local terms and languages, and deliver the message in such a way that it is meaningful to the community.Veterinarians and eco-health specialists should join the investigation to conduct studies collecting specimens from animals and the environment in the outbreak settings.Zoonotic and environmental investigations during an NiV outbreak primarily aim to determine the primary reservoir, likely source of the virus, route of transmission and the extent of the spread of the virus in animals. Georeferenced positive specimens could be analysed with positive human cases to better understand the dynamics of transmission.4.4. ResponseAs soon as a Nipah outbreak is confirmed, national authorities should implement control measures based on known risk factors. The interventions should be based on a multisectoral approach and include/understand the following strategic objectives:1. Establishment of a coordination committee for outbreak prevention, and control activities and resources mobilization; the role of this committee is to ensure the general coordination of operations. It must clearly define the responsibilities of the various teams and the route of information during outbreak response operations.2. Setting up partnerships with the media to ensure media monitoring and better risk communication.3. Formation of a referral system with the principal objective of easing transfer of cases to the appropriate case-management health-care settings.a. Active detection for new Nipah cases and their transfer to the case-management ward.b. Follow up all contacts during 18 days after their last unprotected exposure to Nipah patient(s) or infected animal or tissue (e.g., laboratory) and their transfer to the case-management ward if they fall sick.4. Set up a social mobilization and medical education programme whose principal role is to inform the public and promote practices that decrease community transmission of the disease.5. At the foci zone, the medical team should ensure safe case management of Nipah patients by complying with the following guidelines:a. Respect patients and their families’ dignity and rights, in particular their right for information on disease and treatment,b. Set up a specific Nipah case-management ward that ensures biosafety of in-patient care,c. Set up infection prevention and control measures for safe patient care,d. Organize the safe transport of patients from their residence to the ward,e. The express consent of patients is necessary for any hospitalization. In the event of patient’s refusal to be hospitalized, the medical team should organize, temporarily, a patient’s care at home with his/her family support.f. Organize safe burials while respecting the funeral ceremony,g. Set up psychosocial support (patients, family, HCWs).6. Outside the foci zone, to prevent secondary foci, the medical team should reinforce standard infection prevention and control measures in health care in all health centres of the affected district and all hospitals catering to the outbreak zone.7. Establishment of links with the animal health sector to:a. Continue monitoring the cause of disease and death in domestic animals and wildlife.b. Test samples and alert public health authorities as needed.c. Control slaughtering/butchering activities of domestic animals and wildlife, at home, and in markets and slaughterhouses.8. Media and communicationa. Designate a spokesperson in the outbreak team.b. Designate a spokesperson at the national level who communicates with national media.c. Regularly update reports to be sent to assigned authority.d. Conduct regular meetings with press and community.e. Distribute information, education and communication material.4.5. In the aftermath of the outbreak (evaluation)4.5.1. Declare the end of the outbreakThe health ministry declares the end of the outbreak. The date of outbreak end is equal to twice the mean incubation period for Nipah counted from the last infectious contact with a confirmed or probable case.The national authorities should use the announcement of the end of the outbreak to acknowledge national and international field teams as well as the media. They should also formally present their solidarity and their empathy to the victims, their families and the affected populations.4.5.2. Writing a final report of the outbreak control activitiesThe report objective is to describe the activities undertaken during the epidemic as well as constraints and difficulties encountered. It should include technical aspects (final epidemiological analysis, clinical investigations, etc.), as well as administrative and financial aspects. The report should be published to achieve wider dissemination of findings and lessons learnt.4.5.3. Archive outbreak documents and files• Gather all the reports, files, photographs, videos and other documents related to the outbreak management.• Store all the documents in a place accessible for their later use.4.5.4. Evaluate the management of the outbreakThe evaluation of the management of the outbreak response will review the performance of the various components of the strategy: coordination, relationship to the media, surveillance system, social mobilization programme, clinical management and logistics.The aim of the evaluation is to determine lessons learnt to improve the future management of epidemics. This evaluation should be led by a team comprising national and technical partners.4.5.5. To resume activities of the pre-outbreak period